We monitor sanction activity from state medical boards, CMS, OIG and other regulatory bodies. If we find a care provider has a sanction that results in loss of license or material restriction, we terminate them from our network.
Care Provider Office Site Quality Review
We have office site standards that you must follow, including:
- Physical accessibility, such as handicapped accessible;
- Physical appearance;
- Adequacy of waiting and examining room space;
- Availability of appointments; and
- Adequacy of treatment record keeping (e.g., secure/confidential filing system).
We continually monitor member complaints relating to these standards against our established complaint threshold. If we receive a member complaint within 60 days of the threshold being met, we conduct a full-assessment site visit.
We use a standardized site visit survey form that lists officesite and medical/treatment record-keeping standards.
Based on the results of the site visit, we start corrective action to improve those office sites that do not meet thresholds. We evaluate the effectiveness of those actions at least every six months via follow-up visits, until offices meet the thresholds. We document each step of the process.